Solutions to managing pain are known. However, the management of post-operative pain in children is an art and a science that has yet to be perfected. While research findings differ widely on medications, methods, and timing of interventions to manage post-operative pain, one finding is consistently reported: the treatment of pediatric post-operative pain is suboptimal. Reasons for this deficiency originate in biases of clinicians and parents, difficulties in assessing pain due to variances in physical and developmental levels of children, and lack of research in best practices for pediatric pain management. Because hospital stays are reduced, parents or caregivers must often manage this pain at home. Therefore, educating these primary caregivers in the safe, effective use of pain medications, the reduction of side effects, and the appropriate tapering of the medications is paramount. It is also complex and multifaceted. Preferred methods of patient education are under much scrutiny and the needs of this group of learners are extensive. It is not enough to teach on just the cognitive level. Psychosocial, cultural, and environmental factors impact both the learning and the perceived need for managing children's post-operative pain management at home. Presently, a learning device that addresses these barriers and provides a simple guide for medication management is not available.
While all patients, adult and pediatric, need such a learning device, children are at unique risk for the under treatment of pain because they lack the verbal ability and personal power to demand adequate pain management, and they often do not understand the reason for their suffering. This increased risk poses the single greatest reason for focusing on pain management for this special group of patients. Compounding this risk are the frequent experiences with pain due to the necessity of repeated and ongoing interventions.
The three primary types of pain are nociceptive, inflammatory, and pathological. The post-operative pain generally referred to in this paper is inflammatory pain. Inflammatory pain assists in the healing of the injured body part by creating a situation that discourages physical contact and movement, which reduces further risk of damage and promotes recovery. This type of pain is activated by the immune system and although considered adaptive, reduction in this pain is still vital. Untreated or poorly controlled pain can acutely lead to tachycardia, hypertension, decrease in alveolar ventilation, insomnia, and poor wound healing. Unrelieved acute pain can lead to chronic complications such as chronic pain, sustained changes in central neural functioning, and psychological problems such as heightened pain intensity, anxiety, and post-traumatic stress. In fact it is well known that inadequate treatment of pain contributes to higher rates of complications and lower quality of life and is the most common reason people present for health care. Pain costs society billions of dollars annually, and pain can have a widespread impact on all aspects of life. Despite its recognized significance and the volumes of research dedicated to its management, pain continues to be undertreated especially in children.
As hospital stays following inpatient surgeries become shorter, parents of these children must also learn to manage post-operative pain at home in a shorter period of time. While children are hospitalized, hospital staff use a multimodal approach to pain management employing such techniques as local and regional analgesia, intravenous and intramuscular pain medications, patient controlled analgesia (PCA) techniques, continuous epidural anesthesia and multiple adjunctive agents. Parents at home do not have access to most of these modalities. Therefore, the medications and non-pharmacological techniques for managing post-operative care at home must be used to their utmost effectiveness in order to manage this pain. Because most of these caregivers are not health care professionals, these parents must be taught to be skilled caregivers and knowledgeable pharmacological providers for their children after discharge.
Therefore, what is needed is a device and method that assists post-operative patients and families in the timing, the dosing, and, ultimately, the elimination of pain medications. In particular a simple tool and method are needed that reduce pain and discomfort; maximize health and function; minimize complications and side effects; and allows the patient to taper off medication in a safe manner by assisting in planning pain medication times and in reducing medication usage over time.